The use of a dermatome to harvest a skin graft is a familiar sight within any modern plastic surgery operating room. But how and when did the practice of skin grafting start? (1/14)
#plasticsurgery #historyofmedicine
#plasticsurgery #historyofmedicine
According to some accounts, the use of skin grafts can be traced back to ancient India, where the Tilemaker caste utilised skin taken from the gluteal region, which they then beat with wooden slippers, in the correction of nasal defects incurred as punishment. (2/14)
The use of skin grafts then disappeared for 2,500 years and re-emerged in the 19th Century with reports by Cooper and Bünger of their successful use of skin grafts in humans. Bünger published on his work in 1823. (3/14)
Bünger’s graft was an oval approx. 8 x 10cm. He described how he ‘slapped’ it in order to ‘increase its vitality’ and then shaped it and trimmed the excess fat from it so as to create a ‘truly first-rate, exact union’ and applied it over an hour after harvesting it. (4/14)
Bünger wrote: “We [sic] did not believe our eyes when we saw that a graft which the day before had been chalk-white and had been deprived of the vital forces [sic] for at least 90 minutes, now had become a nose which for the most part had a pure scarlet colour.” (5/14)
Despite his success, the idea did not catch on. It wasn’t until 40 years later, when Reverdin described his use of ‘pinch grafts’ the practice of skin grafting took off.
He noted that skin growth could occur spontaneously from islands of epithelium within a wound (6/14)
He noted that skin growth could occur spontaneously from islands of epithelium within a wound (6/14)
He described a technique where skin was pinched and a small piece was cut off and placed, as an island of epithelium, onto the recipient site. This technique led to the invention of scissors, which included skin forceps, that could be used to harvest these grafts (7/14)
Following this, in 1872 & 1886, Ollier and then Thiersch described the successful use of large grafts that included epidermis and only part of dermis, and the name Ollier-Thiersch graft endured long into the 20th century until they became known as ‘split-thickness grafts’ (8/14)
In 1875, Wolfe introduced a skin graft that contain all epidermis and dermis down to subcutaneous fat, and these were known as ‘Wolfe grafts’, until ‘full-thickness graft’ became the norm. He was a firm defendant that his grafts were superior to Ollier-Thiersch grafts. (9/14)
The traditional way to harvest a SSG was with a knife, and numerous designs were created. Initially an amputating knife was used, then specific Thiersch knives were created. Later, surgeons such as Blair created their own knives for this purpose. (10/14)
None of these knives had guards and all required the user to be proficient at harvesting grafts of the desired thickness. Later Hoffman and then Humby, amongst others, introduced knives that allowed the user to set the required thickness. (11/14)
In 1939, just prior to WW2, Padgett and Hood revolutionised skin grafting with their invention of the ‘Padgett-Hood dermatome’, which consists of a metallic drum that adhered to the donor site. An attached blade then rotates around the drum, harvesting the skin graft. (12/14)
This instrument still required a skilled operator. In a correspondence Blair said this to Harold Gillies about the device: “Well, Gillies, it’s a very nice instrument. I’ve seen it used and it seems good, but like the Rolls Royce motor-care it needs a good chauffeur!” (13/14)
The dermatome, as we know it today, was envisaged by Harry Brown and Milford Barron in 1946, with the first procedure using his new ‘Electro-dermatome’ taking place in 1947. It is this device that the familiar instrument that we use today is based upon. (14/14)
